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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243806341
Report Date: 07/09/2019
Date Signed: 07/09/2019 11:04:40 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:RODRIGUEZ, MARIA FAMILY CHILD CAREFACILITY NUMBER:
243806341
ADMINISTRATOR:RODRIGUEZ, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 580-4645
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY:14CENSUS: 13DATE:
07/09/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Maria Rodriguez - LicenseeTIME COMPLETED:
11:15 AM
NARRATIVE
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(2) Licensing Program Analyst, Joseph Pacheco, conducted an unannounced Annual/Random inspection today. LPA met with Licensee, Maria Rodriguez, toured the home, and census was taken. Also present during the inspection was the Licensee’s husband who is also her assistant. There is a fireplace in the living room and Licensee states it is not used during day-care hours and is screened to make inaccessible to children. There is a working fire extinguisher and smoke detector, and there is adequate heating and ventilation for safety and comfort. LPA observed that the Carbon Monoxide Detector was not working. There are no stairs in the home. Off-limits rooms are made inaccessible by use of plastic spinning knobs. There is a working telephone. Adequate supervision is being provided during this visit. Children are supervised when outside in the backyard play area. Licensee has no pets at this home. Licensee is aware of child safety around pets and accepts responsibility for any action taken by pets. Capacity as specified on the license is being maintained. Staff-child ratios are maintained. Fire drills are conducted and documented with the date and time every six months. The most recent fire drill was conducted on 2/18/19. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present at this home. Pediatric CPR/First Aid are current and expire on 5/11/2020. Immunization’s for staff was reviewed and verified. Licensee stated to LPA that neither she or her husband have completed the required AB 1207 Mandated Reporter training. Licensee stated to LPA that she was unaware of this requirement. LPA provided Licensee with information on how to complete AB 1207 Mandated Reporter training.

Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm



CONTINUED ON 809-C
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: RODRIGUEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 243806341
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/09/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/16/2019
Section Cited
HSC
1597.543
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Carbon monoxide detectors required; inspection. Every family day care home for children shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12.
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Licensee to purchase a carbon monoxide detector and install. Send photograph showing installation of the unit and copy of the receipt showing purchase. Send to CCL by 7/16/19.
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The department shall account for the presence of these detectors during inspections. This requirement was not met as evidenced by: LPA observation of no working Carbon Monoxide detector during today's inspection. This item poses a potential risk to the health, safety, or Personal rights of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: RODRIGUEZ, MARIA FAMILY CHILD CARE
FACILITY NUMBER: 243806341
VISIT DATE: 07/09/2019
NARRATIVE
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An exit interview was conducted with Licensee. LPA provided Licensee with information regarding providing incidental medical services to children, the CDSS Provider Information Notices (PINs) communication system, and some important resources and information links offered on the CDSS website. Lead safety information was provided in accordance with AB 2370, Chapter 676, Statues of 2018.

Hours of operation are Monday through Friday, 6:00am – 6:00pm.

Per Chapter 3, Division 12, Title 22 of the California Code of Regulations, the following deficiencies are found
(see 809-D):

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Joseph PachecoTELEPHONE: (559) 341-4457
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3